One Welfare?

Recently a colleague sent me an article that appeared to build on the concept of “One Health Ethics” mentioned in this blog last year (see OneHealth ethics) . Two veterinarians, enrolled in the Congressional Science and Engineering Fellows Program of the American Association for the Advancement of Science have examined the concepts of human welfare, animal welfare, and the welfare of the environment, and proposed that there is a need for a “One Welfare” approach to a large number of issues that cuts across traditional divisions. 

We are not talking about food stamps and entitlements here, we are talking about the need for society to "make decisions in an interdisciplinary frame with a focus on action and a mission of balancing and promoting human and animal welfare in connected ecosystems and societies."

This seems like a welcome antidote to the discussions of human or animal welfare that at times seem to pit one species against each other, or the cost benefit analyses that suggest environmental degradation may be an inevitable a price tag for economic development . It will be interesting to see whether others pick up this theme and begin developing practical applications. 

For One Health Approaches to Succeed, Information Needs to Flow

In considering the different aspects of integrated approaches to human, animal and environmental health along a One Health paradigm, so many of the challenges seem to boil down to the challenge of how to get information to flow in ways it has not in the past. Here are some examples:  

Disease Surveillance:

A number of groups, including the National Academy of Sciences have called for the development of systems that integrate human and animal disease surveillance data. This could allow for improved detection of emerging disease threats in the environment, both infectious and toxic. The Yale Human Animal MedicineProject has performed analyses supporting the promise of such data integration.  But at present, disease surveillance is collected separately by human and animal health agencies, and not shared in a systematic fashion. As a result, we are still limited in our understanding of what the occurrence of disease events in animal populations (think white nose syndrome in bats or colony collapse in honeybees) means for human health. The Canary Database is one resource for at least examining this issue. We are also therefore limited in our ability to detect and predict human health problems related to environmental change. It will take political as well as scientific will to reorganize such information sharing, but it needs to happen.

Environmental risk data:

Part of the challenge of integrating human, animal, and environmental health is having adequate data about environmental risks, whether climate change, wildlife populations, or degree of contamination by biological, chemical, and/or physical hazards. While animal disease data can provide “sentinel” information about environmental risk “shared” by animals and humans, there is often a need to better characterize environments: getting this information often involves getting out in the environment and finding out what is going on, and transmitting that information to both human health and public health and animal health professionals.

 Genomic data:

The genomes of humans and animals hold the key to better understanding key differences and similarities between species that could help improve the health of both humans and animals, discovering new approaches to disease detection and treatment- see Zoobiquity.  Yet this information is complex and vast- and to use it better will take development of new technological approaches for comparing and exploring these genetic linkages. In addition, better understanding of the genetic characteristics of the pathogens that cross between humans and animals (such as influenza) can help anticipate and prevent outbreaks of zoonotic diseases affecting both human and animal populations. The Human Animal Medicine Project is working with several efforts to assemble and analyze genomic data about pathogens, including the GAINS database and Zoophy. Recent breakthroughs in DNA sequencing technology have produced vast databases of such genetic information- what is needed is a path through this thicket of data.

The Microbiome:

A related wealth of genetic information is accumulating about the human “microbiome”: the communities of microbes that call our gut, skin, and other surfaces home, and seem to have a large effect on our health and wellness. How do our microbiomes differ from those of our companion animals or other animals that we contact on a regular basis?  Is the sharing of microbes between humans and animals all negative or could there be some positive aspects to it that have evolved over millennia of coexistence between humans and animals? The Human Animal Medicine project is performing some pilot analyses of this in workers with close exposure to livestock.

Occupational Risk:

On a more basic level, when workers have close contact with animals, such as swine workers working in large production facilities, there is a need to supply them (and their employers) with better information about their occupational risk and ways to reduce such risk. Such information, such as the amount of virus or bacteria that is present in the air and surfaces of barns and other facilities may be critical to decisions about how to protect workers and reduce disease transmission. While this may seem to be sensitive information, better awareness of such information could actually benefit both human health (occupational and food safety) as well as the health of the animals. The Human Animal medicine project is piloting such approaches in workplaces.

The promise of One Health is the concept of rapid information flow between human, animal, and environmental health, allowing for early detection and prevention of emerging disease risks. If these pilot efforts and similar initiatives around the globe continue to bear fruit there is a chance that we are moving in the right direction toward a world with improved health across multiple species in a healthy environment.

The Dog That Was A Canary

A 60 year old factory worker was seen at the Yale Occupational and Environmental Medicine Program for an elevated urine mercury level. He worked in a factory making mercury vapor light bulbs. The company doctor had removed him from work because of a high mercury level, but even staying home the level of mercury in his urine continued to rise. The workman’s compensation carrier had questioned whether there could be a problem with his urine mercury testing results.

During the clinical evaluation, the patient recalled that he had brought his work boots home and had been using them for the past several weeks. When he had checked inside his boots, he found beads of mercury under the soles.

As part of his evaluation, the clinic’s industrial hygienist performed a site visit to his home, in conjunction with the State Dept of Public Health. Real time measurement of mercury vapor in the house showed a number of slightly elevated areas. At the site visit, it was also noticed that the patient had a 3 month old German shepherd puppy. Since there was still a question about whether the house was sufficiently contaminated with mercury to cause the patients elevated level, the dog’s veterinarian was contacted (with the owner’s permission) to arrange for mercury testing of the dog. The dog’s urine showed a mercury level that was five times normal!

Both the man and his dog were advised to move out of the apartment, and the apartment was cleaned of mercury. After a month, dog and human returned to the house, and the man’s mercury levels continued to return towards normal.

Mercury is an important toxic exposure in both workplaces and the environment. Elemental mercury (quicksilver) vapor can be inhaled and cause toxic effects to the brain, kidney, and developing fetus. Workers can bring home mercury from work on shoes and clothes and contaminate a home, as in this case. Lead can also be tracked into a house by workers who are exposed at their job.

This case illustrates that pets and other animals can serve as “sentinels” for toxic exposures in the home, just as canaries once warned miners about dangerous gases. In particular, household dogs and cats have provided warning to nearby humans in the household about lead poisoning as well as carbon monoxide poisoning as well as other toxic hazards. Communication between veterinarians and physicians may help detect hazardous exposures affecting both animals and humans. The Yale Human Animal Medicine Project  maintains the “Canary Database” of evidence about animals as sentinels of human environmental health hazards (http://canarydatabase.org).
See for example the Canary summary for animals as sentinels of lead poisoning: 

Lead as Sentinel Exposure

and the following papers in the database: 

Childhood plumbism identified after lead poisoning in household pets.

"Veterinary" diagnosis of lead poisoning in pregnancy

What’s New About “Zoobiquity”?

 I just finished reading my copy of the new book Zoobiquity: What Animals Can Teach us about Health and the Science of Healing, by Barbara Natterson-Horowitz and Kathryn Bowers. It is a ground-breaking book and essential reading for anyone interested in the connections between human and animal medicine. The authors illustrate, through a large number of side by side comparisons, the striking parallels between clinical conditions in animals and humans, and what these similarities can suggest about the root causes of disease (including evolution and environment) and how best to treat them. Readers familiar with “One Health” concepts will find in the book vivid examples of the convergence of human, animal, and environmental health in emerging infectious diseases and animals as sentinels of toxic and infectious hazards in the environment. Yet, it is worth focusing on some of the truly innovative aspects of this book. First, Zoobiquity boldly asserts that by neglecting its comparative medicine roots, clinical medicine itself has gone astray and the medical profession needs to use the perspective of clinical science that spans different species to get back on track. We need to understand mental health problems such as addiction and self-destructive behaviors in the context of evolution and environment, just as naturalists and veterinarians strive to do, and use this perspective to design new treatment and prevention approaches. Similarly, we need to use the same tools of evolutionary and environmental understanding to rethink our approaches to chronic diseases such as obesity and cancer. Second, Zoobiquity builds the strongest case to date for greater development of clinical knowledge of animal health using techniques that are driving evidence based medicine such as randomized trials and large observational cohorts followed over time in order to glean important information useful for both animal and human health. Third, the concepts in Zoobiquity are presented so clearly and documented so extensively that they appear to have struck a chord in both the general population (see Oprah’s 2012 summer reading list) and the medical community that propels the discussion of human animal medicine linkages to a whole new level. Overall, Zoobiquity throws a gauntlet out to the biomedical scientific and clinical community, urging it not to delay further, but instead to set up an effective research and development infrastructure to pilot and test new hypotheses and clinical approaches using this enhanced comparative model It will be fascinating to see who comes forward to accept this challenge.